Minority Race Predicts Treatment by Non-gynecologic Oncologists in Women with Gynecologic Cancer
- 45 Downloads
Outcomes of women with gynecologic cancer are superior when treated by gynecologic oncologists. The National Surgical Quality Improvement Program (NSQIP) began identifying gynecologic surgeon subspecialty in 2014. We sought to identify characteristics and outcomes of women treated by general gynecologists in comparison with women treated by gynecologic oncologists.
Patients and Methods
Patients undergoing hysterectomy for gynecologic malignancy in 2014 and 2015 were abstracted from the NSQIP database. Patient characteristics, morbidities, surgeon specialty, and operative outcomes were captured.
7271 hysterectomies were performed for malignant disease, and 669 were performed by generalists. In comparison with generalists, gynecologic oncologists operated on patients who were older (P < 0.001), more likely to be White [odds ratio (OR) 2.1, P < 0.001], had disseminated cancer (OR 3.1, P < 0.001), had ascites (OR 2.6, P < 0.001), and were classified as American Society of Anesthesiologists (ASA) class ≥ 3 (OR 1.7, P < 0.001). Gynecologic oncologists were also more likely to have hospital readmissions (OR 1.7, P = 0.004) and perform lymph node dissections for endometrial cancer (OR 2.2, P < 0.001). On multivariable analysis, older age [adjusted OR (aOR) 1.0, P = 0.021], White race (aOR 2.0, P < 0.001), presence of disseminated cancer (aOR 2.5, P < 0.001), presence of ascites (aOR 1.8, P = 0.036), and ASA class ≥ 3 (aOR 1.6, P < 0.001) remained independent predictive factors for having a gynecologic oncology surgeon.
The majority of gynecologic cancer cases are performed by gynecologic oncologists. Generalists are more likely to operate on minority patients and patients with fewer comorbidities. Further efforts to ensure access to specialized cancer care for all patients are needed.
The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. All authors declare that they have no conflicts of interest related to this work.
- 5.National Comprehensive Cancer Network. Cervical Cancer (Version 1.2018). January 7, 2018; https://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf.
- 12.National Cancer Institute. Cancer Stats Facts: Ovarian Cancer. Cited 2017 May 1; https://seer.cancer.gov/statfacts/html/ovary.html.
- 13.National Cancer Institute. Cancer Stat Facts: Cervix Uteri Cancer. Cited 2017 May 1; https://seer.cancer.gov/statfacts/html/cervix.html.
- 14.National Cancer Institute. Cancer Stat Facts: Endometrial Cancer. Cited 2017 May 1; https://seer.cancer.gov/statfacts/html/corp.html.
- 15.American Society of Anesthesiologists. ASA Physical Status Classification System. Cited 2017 May 2; https://www.asahq.org/resources/clinical-information/asa-physical-status-classification-system.
- 16.American Hospital Association. Fast Facts on US Hospitals. Cited 2017 May 3; http://www.aha.org/research/rc/stat-studies/fast-facts.shtml.
- 19.Chatterjee S. et al. Disparities in gynecological malignancies. Front Oncol. 6:36.Google Scholar
- 20.Kohler BA, et al. Annual report to the nation on the status of cancer, 1975–2011, featuring incidence of breast cancer subtypes by race/ethnicity, poverty, and state. J Natl Cancer Inst. 2015;107(6):djv048.Google Scholar